NPIMap

Organization Active NPI

Vision Source Maitland, LLC

Doing business as Vision Source

  • Optometrist
  • Oviedo, FL
National Provider Identifier
1033283288
Registry record updated Feb 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPC003166 Issued in FL
Legal business name
VISION SOURCE MAITLAND, LLC
Doing business as
Vision Source
Practice address
1020 Lockwood Blvd
Oviedo, FL 32765-6027
Phone
(407) 971-1001
Fax
(407) 971-1002
NPI assigned
Nov 20, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 11, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
David N Fisher, ODNPI 1598875809
Title
Ceo
Phone
(407) 971-1001

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X OPC003166 FL Primary

Addresses

Primary practice location

1020 Lockwood Blvd
Oviedo, FL 32765-6027

Mailing address

1020 Lockwood Blvd
Oviedo, FL 32765-6027
Phone (407) 971-1001

Other names 1

  • Vision Source Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050829000234 FL Part B Supplier - Clinic/Group Practice 3375574429 Receives reassigned benefits from 7 practitioners
Practice locations: Oviedo, FL
O20240803000143 FL Part B Supplier - Clinic/Group Practice 8921545369 Receives reassigned benefits from 4 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Winter Springs, FL; Oviedo, FL; Maitland, FL

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Vision Source Maitland LLC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

238 S Orlando Ave
Maitland, FL 32751
Phone (407) 971-1001

1020 Lockwood Blvd
Oviedo, FL 32765
Phone (407) 971-1001

1783 E Broadway St
Oviedo, FL 32765
Phone (407) 971-1001

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163980800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1739232000000",
    "number": "1033283288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1020 LOCKWOOD BLVD",
            "city": "OVIEDO",
            "state": "FL",
            "postal_code": "327656027",
            "telephone_number": "407-971-1001",
            "fax_number": "407-971-1002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1020 LOCKWOOD BLVD",
            "city": "OVIEDO",
            "state": "FL",
            "postal_code": "327656027",
            "telephone_number": "407-971-1001",
            "fax_number": "407-971-1002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VISION SOURCE MAITLAND, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-20",
        "last_updated": "2025-02-11",
        "certification_date": "2025-02-11",
        "status": "A",
        "authorized_official_last_name": "FISHER",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "407-971-1001",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "FL",
            "license": "OPC003166",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Vision Source",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Oviedo, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.